The following services and supplies are never covered by, and shall not be authorized or reimbursed by, the bureau or MCO:
(A) Services and supplies that are never covered pursuant to other bureau statutes or rules.
(B) The following services and supplies, which are never considered to be durable medical equipment by the bureau:
(1) Home furniture including, but not limited to: reclining chairs, non-hospital beds, water beds, lounge beds (such as adjust-a-sleep adjustable bed, craftmatic adjustable bed, electropedic adjustable bed, simmons beautyrest adjustable bed). The bureau or MCO shall reimburse for a seat lift mechanism when medically necessary and appropriate for an injured worker who requires a mobility aid to stand from a seated position due to physical limitations that are reasonably related to the industrial injury (allowed conditions). However, the bureau or MCO shall not reimburse for the chair (furniture);
(2) A mattress for a non-hospital bed (including, but not limited to: tempur-pedic, angelbed, memory foam mattresses). Reimbursement for a hospital bed mattress is limited to a twin/single size only. The bureau or MCO will not reimburse for a double, queen or king size mattress for the purpose of accommodating two people;
(3) Home exercise equipment, including but not limited to such equipment as treadmills and exercise bikes;
(4) Home whirlpools, including built-in whirlpools and pumps, portable hydrotherapy pools, jacuzzi tubs, portable saunas and spas, non-portable hot tubs or whirlpools, and therasaunas.
(5) Unsupervised physical reconditioning programs, including but not limited to memberships to or services provided at a health club, YMCA, spa or nautilus facility, except when the criteria have been met for an injured worker who is participating in a vocational rehabilitation or remain at work program.
(C) Self-administered sympathetic therapy/interferential therapy.
(D) Prescription smoking deterrent drugs outside an approved smoking cessation program, except when dispensed while the injured worker is admitted to a hospital during an approved inpatient admission or during the course of an outpatient visit in a hospital.
(E) Drug screening of injured workers performed by employers or performed in the emergency room at the time of injury at the request of the employer.
Five Year Review (FYR) Dates: 08/26/2015 and 08/25/2020
Promulgated Under: 119.03
Statutory Authority: 4121.12, 4121.121, 4121.30, 4121.31, 4121.44, 4121.441, 4123.05
Rule Amplifies: 4121.12, 4121.12, 4121.44, 4121.444
Prior Effective Dates: 12/11/12